NHS Funding Bill

Baroness Winterton of Doncaster Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

It is a pleasure to call Peter Gibson to give his maiden speech.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I am aware that a large number of right hon. and hon. Members have come into the Chamber to hear the maiden speeches, quite rightly, but it is important that we also listen to other contributions. There was a bit of chatter going on before, so it would be very respectful if we all listened to each other’s speeches.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

It is a pleasure to call Lee Anderson to make his maiden speech.

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[Lee Anderson]

This is my speech; thank you, Eddie.

My hon. Friend the Member for Bassetlaw has only mentioned his 14,000 majority on one occasion to me—sorry, once a night as we go home across Westminster bridge. He tells me every single night, but I pay him great respect—he certainly has raised the bar.

Ashfield was once voted the best place in the world to live—by me and my mates one Sunday afternoon in the local Wetherspoons. It really is the best place. Ashfield is a typical mining constituency. To the south of the constituency we have Eastwood, birthplace of D.H. Lawrence, to the north we have Nuncargate, birthplace of our most famous cricketer, Harold Larwood, and further north we have Teversal, which is where D.H. Lawrence wrote probably his most famous novel, “Lady Chatterley’s Lover”—a book I have read several times. We have many other great towns and villages in Ashfield, such as Sutton, Kirkby, Annesley, Selston, Jacksdale, Westwood, Bagthorpe and Stanton Hill, but the place that is closest to my heart in Ashfield is the place where I grew up, a mining village called Huthwaite.

Like with many villages, when I was growing up in the 1970s most of the men in Huthwaite worked down the pits. I went to a school called John Davies Primary School, and I was always told at school in the ’70s, as many of us were, “Work hard, lad, do well, take the 11-plus, go to grammar school and you’ll not have to go down the pit like your dad and your granddad and your uncles.” Unfortunately, a couple of years before we were due to take our 11-plus, the Labour Government at the time withdrew it from our curriculum, so I was unable to go to grammar school, and none of our school went as a consequence of that. Just a few years later I was down the pit with my dad—working at the pit where my granddad and my uncles had worked. I did that for many years and I am sure my dad, who is watching this right now—a decent, hard-working, working-class bloke—did not want me down the pit. He wanted better for me, but that was taken away. I cannot help but think that, had children in my day had the chance to go to grammar school, they would have had more opportunities and probably a better life. Because I am telling you now, when I worked down those pits in Nottinghamshire, I worked with doctors, with brain surgeons, with airline pilots, with astronauts—with all these brilliant people who never a chance. The Prime Minister is quite right when he says that talent is spread evenly across this country but opportunity is not, and my constituency is living proof of that.

People of Ashfield are a straight-talking bunch—a bit dry, a wicked sense of humour, a bit sarcastic sometimes—but that is borne out of our tough industrial past. You have to remember that we were the people who dug the coal to fuel the nation. We were the people who sent our young people—our young men and women—to war to die for this country. We were the people who made the clothes that clothed the nation. And we were the people who brewed the beer that got us all persistently drunk every single weekend.

In 1993, under a Conservative Government, we reopened the Robin Hood line in Ashfield, and all through the county of Nottinghamshire, which created endless opportunities for passengers to travel for work, for play and for jobs. Standing here as a Conservative MP in 2020, I am proud to say that this Government are once again looking at extending our Robin Hood line to cover the rest of the county. They are also looking at reopening the Maid Marion line, which will again carry passengers to the most isolated and rural areas of our country. It is all well and good having good education and good training, but transport means just as much to the people in my community.

My friends, family and constituents have asked me every single day what it is like to be down here in Westminster. I say, “It’s brilliant—amazing. We’ve got great staff—the doorkeepers.” Every single person who works here has been absolutely brilliant to me. It is an amazing place. I have met all these famous people—I have met MPs, Lords and Ministers—but the best moment for me was last Wednesday night, when I got invited to Downing Street, to No. 10, for the first time ever in my life. I walked through that door and there he was, the man himself—Larry the Cat. [Laughter.] Told you we were funny.

I was born at the brilliant King’s Mill Hospital in Ashfield. King’s Mill was built by the American army during world war two to look after its injured service personnel. After the war, the American Government gave King’s Mill Hospital—the buildings and equipment—to the people of Ashfield as a thank-you gift. What a wonderful gift that is from our American cousins—absolutely stunning. I cannot praise the current staff and management at King’s Mill highly enough. They have really turned things around. Just 20-odd years after the American Government gave King’s Mill Hospital to the people of Ashford, I was born there, and later my children were born there.

It is not just our hospital in Ashfield that means a lot to me; it is the fact that it has saved my wife’s life for many, many years now. My wife was born with a condition called cystic fibrosis. She was not diagnosed until she was 18, and for anybody, to be told that they have cystic fibrosis is like getting an early death sentence. But undeterred, my wife—my beautiful wife—went to work for a year. She then went to university, she studied, she became a teacher and she taught for 10 years, until she got to her early 30s, when she could not really carry on any more and gave up work. All that time, our brilliant NHS staff looked after her and kept her alive—I cannot thank them enough—but things got really bad in her mid-30s and she had to go on the list for a double lung transplant. She was on that list for two years, and we had five false alarms before we finally got the call on 19 December 2016. The operation was 14 hours and she spent three days in critical care. I thank my lucky stars for our brilliant NHS. They looked after her, they have kept her alive, and last year she was elected as a Conservative councillor in our home town.

I am incredibly proud, and when people say that this party is a party of privilege, I say to them, “I’m privileged to be in this party.”

[Madam Deputy Speaker (Dame Rosie Winterton)]

It is a pleasure to call Neale Hanvey to make his maiden speech.

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[Grahame Morris (Easington) (Lab)]

It is a pleasure to follow the hon. Member for Dover (Mrs Elphicke), who made powerful arguments in support of improving maternity services in her area, as well as other hon. Members who made their maiden speeches this evening. I am sure that we will hear a lot more from them.

I want to make a familiar argument about access to and funding of radiotherapy services. The Minister for Health, the hon. Member for Charnwood (Edward Argar), has heard this argument on previous occasions, but I am going to make it again because I am not convinced that the Secretary of State understands it. It is not rocket science: in the United Kingdom, radiotherapy accounts for just £383 million of the NHS resource budget, despite the fact that one in four of us is going to need it at some point in our lives. In his opening remarks, the Secretary of State referred to the Government’s commitment to invest in new diagnostic equipment and scanners. I very much welcome that, but he did not seem to get—I did not hear the penny dropping—the important link between diagnosis and treatment.

I must declare an interest: I am vice-chair of the all-party parliamentary group on radiotherapy. I am a cancer survivor myself and have benefited from this particular treatment. Basically, I want to make three points. I want to cover the cancer challenge, to briefly discuss the current state of radiotherapy and to set out a future vision for NHS radiotherapy. I am talking in the context of the Bill. I have tried to make key points in interventions about how vital workforce planning and capital budgets are. This is not just a case of replacing hospital car parks; it is about vital equipment. It is essential to improve cancer outcomes for our patients.

About 50% of people develop cancer at some time in their lives, and I am sure that even those fortunate enough to be spared the disease will all have a loved one who has been touched by cancer. I am not arguing from a completely selfish point of view, here—putting a case for me, my constituency or my region. As a magnanimous sort of individual who recognises the sentiment in the House, I am arguing that we should improve cancer services across the whole country. Access to world-class cancer treatment really matters to every single one of our constituents in every constituency in the United Kingdom.

I want to take issue with a statement that the Secretary of State has made on more than one occasion about cancer survival rates. Figures comparing nine comparative countries were published in The Lancet in November last year, just before the election. They showed that the United Kingdom had the lowest survival rates for breast cancer and colon cancer and the second lowest for rectal cancer and cervical cancer. Some 24% of early-diagnosed lung cancer patients are not getting any treatment at all.

In truth, although our cancer survival rates are improving—the Secretary of State is not telling a lie—we still have the worst cancer outcomes in Europe; the baseline is very low. I welcome the Government’s commitment to considering ways to improve cancer diagnosis, with a plan to set new targets so that patients receive cancer results within 28 days. That is great. But we still need to address issues of staff capacity and there is a desperate need for more radiologists and more skilled people in the imaging teams to address shortages in endoscopy, pathology and the vital IT networks.

Unlike chemotherapy, which I have also had on a couple of occasions, which impacts the entire body with chemicals, advanced radiotherapy targets tumours precisely, to within fractions of millimetres, limiting damage to healthy cells in close proximity to the tumour. Improved radiotherapy technology allows us to treat cancers previously treatable only with surgery, chemotherapy or a combination of both. Radiotherapy is also cost-effective for patients, the NHS and Ministers, who are obviously very keen to ensure that we get value for money. A typical course of radiotherapy costs between £3,000 and £6,000—far less than most chemotherapy and immunotherapy cures—and patients experience very few side effects.

The problem is that access to radiotherapy centres and this life-saving treatment is not evenly distributed across the United Kingdom. A 2019 audit showed that 32% of men with locally advanced prostate cancer in the UK had been potentially undertreated, with 15% to 56% of trusts in the survey not offering the sort of radical radiotherapy that those patients really required. In England, advanced curative radiotherapy is actively restricted for no good reason, with only half the 52 centres having been commissioned by NHS England to deliver advanced radiotherapy—stereotactic ablative radiotherapy, or SABR. That is despite the fact that its use is specifically recommended by the National Institute for Health and Care Excellence.

We are coming up to World Cancer Day on 4 February. The Minister understands this issue because we have spent a deal of time on it. I want him to make a commitment on behalf of the Government that the UK will become a world-class centre for patient-first radiotherapy so that we can improve our cancer survival rates. That will require an increase in investment. We need to address the issue of capital funding. Currently, radiotherapy gets 5% of the cancer treatment budget; we need that to be closer to the European average of 11%. There is an immediate need for £140 million of investment to replace the 50 or so radiotherapy machines—the old linear accelerators—that are still in use despite being beyond their recommended 10-year life by the end of 2019. We need investment in IT and to help establish the 11 new radiotherapy networks, which the Minister touched on. Again, that comes under capital and workforce training.

The all-party parliamentary group’s manifesto for radiotherapy is calling for a modest increase in the annual radiotherapy budget, from 5% to 6.5% of the revenue budget, and for the Government to establish some basic standards to secure our vision for radiotherapy. We need to recruit and train highly skilled clinicians, radiographers, medical physicists and healthcare professionals and to guarantee that every cancer patient has access to a radiotherapy centre within a 45-minute travel time. In 2020, the Government should set themselves a 2030 target for the UK to go from having the worst cancer outcomes to the best cancer survival rates in the world. We could do that, and we could make a start by delivering a world-class radiotherapy service.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I am afraid that I have to reduce the time limit to eight minutes.

NHS Funding Bill

Baroness Winterton of Doncaster Excerpts

Legislative Grand Committee & 3rd reading: House of Commons & Legislative Grand Committee: House of Commons & Programme motion: House of Commons & 3rd reading & Programme motion
Tuesday 4th February 2020 Commons Chamber

[The First Deputy Chairman of Ways and Means (Dame Rosie Winterton)]

I remind hon. Members that if there is a Division only Members representing constituencies in England may vote.

Clause 1

Funding Settlement for the health service in England

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I beg to move amendment 2, page 1, line 10, at end insert—

“(1A) The amount spent on mental health services in each financial year set out in the table must be set out in a statement laid before the House of Commons by the Secretary of State no later than 30 June in each year.

(1B) The statement in subsection (1A) must be accompanied by a statement on the Secretary of State’s plans to achieve parity of esteem in mental health services.”

This amendment would require the Secretary of State to report annually on the amount actually spent on mental health services, and on the Secretary of State’s plans to achieve parity of esteem in mental health services.

[The First Deputy Chairman]

With this it will be convenient to discuss the following:

Amendment 1, page 1, line 14, at end insert—

“(2A) For each year in the table in subsection (1), the Secretary of State must specify the amount of the allotment that is for mental health services.”

This amendment requires the Secretary of State to specify the amount to be spent each year on mental health services.

Amendment 5, page 1, line 14, at end insert—

“(2A) For each year in the table in subsection (1), the Secretary of State must specify the amount of the allotment that is for training for staff to improve maternity safety and care for mothers and babies.”

This amendment would require the Secretary of State to specify the amount to be spent each year on improving maternity safety and care for mothers and babies.

Amendment 3, page 1, line 18, at end insert—

“and that the sums set out in the table are not permitted to be augmented by or composed of any virements from NHS capital budgets.”

This amendment would stop the Secretary of State meeting the NHS England allotment for resource spending by using funds from NHS capital budgets.

Clauses 1 and 2 stand part.

New clause 1—Annual report on mental health spending—

“The Secretary of State must lay before the House of Commons an annual statement of the outturn of NHS England spending on mental health services no later than six months after the end of each financial year, beginning with the year ending 31 March 2020 and up to and including the year ending 31 March 2024.”

This new clause requires the Secretary of State to report each year on the actual level of spending on mental health services.

New clause 2—Annual Report on Child and Adolescent Mental Health Services spending—

“(1) The Secretary of State must lay before the House of Commons an annual statement of the outturn of NHS England spending on Child and Adolescent Mental Health Service (CAMHS) no later than six months after the end of each financial year, beginning with the year ending 31 March 2020 and up to and including the year ending 31 March 2024.

(2) The annual statement from subsection (1) must report figures on—

(a) CAMHS expenditure per head,

(b) the percentage of the annual NHS England budget allotted to CAMHS, and

(c) the percentage of the annual mental health budget allotted to CAMHS.

(3) The figures in subsection (2) must be broken down by standard regional units in England or by such territories as the Secretary of State considers appropriate.

(4) Each statement under subsection (1) must include an assessment by the Secretary of State on whether expenditure on CAMHS has met the aims of the NHS Long Term Plan.”

This new clause would require the Secretary of State to report each year on the actual level of spending on CAMHS. It requires figures to be broken down by regional units and for the Secretary of State to include an assessment of whether expenditure on CAMHS is meeting the aims of the NHS Long Term Plan.

New clause 3—Allocation of funding—

“The Secretary of State must lay a report before the House of Commons no later than 31 July each year setting out how much in percentage and in cash terms in relation to the amounts set out at section 1(1) has been spent on mental health services in the most recent year ended on 31 March.”

This new clause would require the Secretary of State to report annually on the amount and proportion of NHS England spending devoted to mental health services.

New clause 4—Annual statement on performance—

“The Secretary of State must make a statement to the House of Commons no later than 31 March each year setting out—

(a) whether in the Secretary of State’s opinion the amount specified in section 1(1) for the following financial year is sufficient to meet the performance targets set out in the NHS constitution, and

(b) if in the Secretary of State’s opinion the amount specified in section 1(1) for the following financial year is not sufficient to meet the performance targets set out in the NHS constitution, what steps Secretary of State is taking to ensure that those targets are met.”

This new clause would require the Secretary of State to report annually on whether the allotment to the health service specified in section 1(1) year is sufficient to meet the performance targets set out in the NHS Constitution and, if not, what steps Secretary of State is taking to ensure that those targets are met.

New clause 5—Inflation—

“(1) The Secretary of State must make a statement to the House of Commons in the event that the annual rate of inflation as set out in the Consumer Prices Index is greater than 3.3% in any six months out of twelve after the date on which this Act is passed.

(2) The statement under subsection (1) must specify whether, and by how much, the allotments to the health service in England set out will exceed the amount specified in the table in section 1(1).”

This new clause would require the Secretary of State to make a statement on the impact of inflation above a certain rate on the allotments to NHS England.

New clause 9—Annual parity of esteem report: spending on mental health and mental illness—

“Within six weeks of the end of each financial year specified in the table, the Secretary of State must lay before each House of Parliament a report on the ways in which the allotment made to NHS England for that financial year contributed to the promotion in England of a comprehensive health service designed to secure improvement—

(a) in the mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of mental illness.”

This new clause would require the Secretary of State for Health and Social Care to make an annual statement on how the funding received by mental health services that year from the overall annual allotment has contributed to the improvement of mental health and the prevention, diagnosis and treatment of mental illness.

New clause 11—Annual review of adequacy of allotment to NHS England—

“The Secretary of State must lay before each House of Parliament within 14 days of the Treasury laying the annual main estimate for the Department of Health and Social Care an assessment of the extent to which changes in the costs of pharmaceutical treatments, medical devices and service delivery since the date on which this Act is passed have affected the health outcomes in England achieved as a result of the amounts in the table in section 1 of this Act allotted to NHS England.”

This new clause would require the Secretary of State to publish an annual assessment of the impact of changes in the costs of pharmaceutical treatments, medical devices and service delivery on the expected outcomes from the allotted amounts under this Act.

[Justin Madders]

It is a pleasure to see you in the Chair, Dame Rosie. In my speech I will address amendment 2 and, as we are dealing with everything in one go, the other amendments and new clauses submitted in my name and the names of my right hon. Friends.

It seems that Members across the House are anxious that the Government’s laudable aims on parity of esteem for mental health services are given some legislative teeth. The NHS long-term plan rightly calls for more investment in mental health services to give mental health the same priority as physical health. That is the right approach and it is one that we support. However, as we can see by the amendments that have been tabled today, there is scepticism about how that will actually be delivered. Investment in mental health services has been seriously neglected in recent years and mental health patients are some of the people who have been most let down by the Government in the last decade.

No doubt we will hear from those on the Government Benches that mental health spending is increasing, and that the funding set out in the Bill will benefit mental health services, but the reality is that on this Government’s watch, we have seen a mental health crisis emerge. We are not getting the investment at the level required and services are simply unable to keep pace with demand. As a consequence, the number of people living with serious mental health problems is rising. Patients are unable to access vital psychological therapies within six weeks and often have to wait over 100 days for talking therapy treatments. Thousands of mental health patients continue to be sent hundreds of miles from home, because their local NHS does not have the beds or the staff to provide the care they need. These are often young people in desperate circumstances being sent away from their family and friends—their support network, as it were—and that to me sounds a long way away from parity of esteem. We know that adults in need of help with eating disorders are waiting more than three years for treatment, while hospital admissions for eating disorders increase year on year. The number of people living with serious mental health problems is continuing to rise and suicide levels are at their highest since 2002.

Even against this awful backdrop, however, it is children’s mental health services that are suffering most from the chronic lack of funding. Children’s mental health services account for just 8% of total mental health spending, and the Government’s continual failure to prioritise children’s mental health has led to services for children effectively being rationed. We know that on average, children and young people visit their GP three times before they get a referral for specialist assessment. They then have to wait more than six months for treatment to start. Suicidal children as young as 12 are having to wait more than two weeks for beds in mental health units to start treatment, despite the obvious risk to their lives.

Three out of four children with mental health conditions do not get the support they need. With over 130,000 referrals to specialist services turned down, despite children showing signs of eating disorders, self-harm or abuse, the problem has become so bad that some children and families are being told by their GPs to pretend that their mental health problem is worse than it is to make sure they get the help they need. Four hundred thousand children and young people with mental health conditions are not receiving any professional help at all—400,000. That is a scandalous figure. We know that mental health conditions in adults often begin in childhood, so it is not only an outrageous dereliction of duty to our young people; it will also end up costing the NHS and society far more in the long run.

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[Drew Hendry (Inverness, Nairn, Badenoch and Strathspey) (SNP)]

I am grateful to my hon. Friend for allowing me to speak in the English Parliament for the first time. Does he agree that one way to get around this whole EVEL conundrum is simply for the English Parliament to be made officially an English Parliament and then we can all have our own national Parliaments in our own countries?

[The First Deputy Chairman of Ways and Means (Dame Rosie Winterton)]

Order. I am sure colleagues will appreciate that it is important that we actually talk about the Bill.

[Patrick Grady]

I wholeheartedly agree, Dame Rosie. I have addressed the amendments that we have an interest in, and I am contextualising why they are relevant to our constituents, but points are being extremely well made by my colleagues. There is a simple solution to this, which we in the SNP have been promoting for 84 years, since 1934: Scotland can become an independent country and England can have the Parliament that it wants. As my hon. Friend the Member for Airdrie and Shotts (Neil Gray) says, with the greatest respect for the Speaker, it should not be for the Chair or for the Government to decide what does and does not apply to Members from different parts of the UK. My job and that of my colleagues is to look at each measure before this House and determine for ourselves whether it is relevant to our constituents and act accordingly. Today, we are being actively prevented from doing that. There are amendments and new clauses on the amendment paper that we deem to be of interest to people in Scotland, which would take forward commitments in our manifesto, but we will not be able to vote for them. That is not a precious Union. That is not a partnership of equals. That is not leading instead of leaving. It is not something that is going to be sustainable for much longer, and 52% of people in Scotland seem inclined to agree.